Internal carotid artery dissection is a rare vascular condition with potentially life-threatening consequences, often resulting in intramural hematomas and luminal narrowing. Various etiological factors, including cocaine use, contribute to its occurrence. This case report explores a striking instance of bilateral internal carotid artery dissection in a middle-aged man with a history of chronic cocaine use, shedding light on the intricate relationship between substance abuse and vascular pathology. We present the case of a 47-year-old man with a significant history of chronic cocaine use presented with sudden-onset severe headaches and visual disturbances, including blurred vision and diplopia. Physical examination revealed signs of Horner's syndrome and neurological involvement. Diagnostic imaging confirmed bilateral internal carotid artery dissections, primarily on the right side, with mural hematoma formation and luminal narrowing. Immediate management included pain control, blood pressure regulation, and discontinuation of cocaine use. The patient's symptoms gradually resolved with anticoagulation therapy, and he was discharged with a comprehensive follow-up plan. This case of bilateral internal carotid artery dissection in a middle-aged man with a history of chronic cocaine use underscores the intricate relationship between this condition and substance abuse. It highlights the need for a comprehensive clinical history to identify potential links between substance use and vascular pathologies. The multidisciplinary approach to diagnosis and management is crucial in optimizing patient outcomes. Addressing substance abuse as a contributing factor to vascular pathology is essential, emphasizing the importance of comprehensive care and support for affected individuals, and contributing valuable insights to the existing literature on vascular pathology.
